Predictors of failure to rescue in surgical rescue

Purpose: To determine the current status of surgical rescue (SR) and examine the predictors of failure to rescue (FTR). In acute care surgery, predictors of FTR have only been reported in patients with trauma, not in SR. Methods: This retrospective study included 142 patients who underwent emergency surgery at our institution between April 2019 and March 2023. The primary outcome was the identification of the FTR predictors using logistic regression analysis. The secondary outcome was the development of a Surgical Rescue Severity Score (SRSS) using these SR predictors and long-term outcomes. Results: The patients were divided into survival and mortality groups (122 and 20, respectively). American Society of Anesthesiologists Physical Status (ASA-PS) and quick sequential organ failure assessment (qSOFA) scores were higher in the mortality group. In contrast, the survival group included more cases of SR necessitated by surgical treatment. In multivariate analysis, ASA-PS ≥ 3 (odds ratio [OR], 5.3; 95% confidence interval [CI] 1.2–36), complications caused by non-surgical therapy (OR, 5.5; 95% CI 1.8–19), and qSOFA score ≥ 2 (OR, 4.5; 95% CI 1.3–17) were independent prognostic factors. The total risk factors for FTR obtained in the multivariate analysis were calculated and established as the SRSS. The long-term prognosis of SR was examined and stratified by the SRSS (P = 0.0001). Conclusion: Predictors of FTR in SR were ASA-PS ≥ 3, qSOFA score ≥ 2, and complications caused by non-surgical therapy. The SRSS stratified the short- and long-term prognoses of SR and predicted prognoses preoperatively.